1. Anxiety and Obsessive-Compulsive Related Disorders
Chapter 15
Anxiety and Obsessive-Compulsive Related Disorders
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2. Anxiety
Anxiety – Apprehension, uneasiness, uncertainty, or dread from real or perceived threat
Fear – Reaction to specific danger
Normal anxiety – Necessary for survival
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

3. Levels of Anxiety Mild anxiety Moderate anxiety Severe anxiety Panic
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

4. Question 1
A parent is shopping with a 5-year-old child in a large, busy urban mall. The parent suddenly realizes the child is missing. Which level of anxiety would likely result?
Mild
Moderate
Severe
Panic
Answer: D
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

5. Case Study
What behaviors might this parent be exhibiting that would indicate panic-level anxiety?
Behaviors that may be manifested are:
Pacing
Running
Shouting
Screaming
Also, physical behavior may become:
Erratic
Uncoordinated
Impulsive
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

6. Defenses Against Anxiety
Defense mechanisms
Automatic coping styles
Protect people from anxiety
Maintain self-image by blocking
Feelings
Conflicts
Memories
Can be healthy or unhealthy
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

7. Clinical Picture Separation anxiety disorder Panic disorder
Developmentally inappropriate levels of concern over being away from a significant other
Panic disorder
Panic attacks
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

8. Clinical Picture (Cont.)
Agoraphobia
Excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing
Specific phobias
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

9. Clinical Picture (Cont.)
Social anxiety disorder
Severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others
Generalized anxiety disorder
Excessive worry that lasts for months
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

10. Clinical Picture (Cont.)
Other anxiety disorders
Substance-induced anxiety disorder
Anxiety due to a medical condition
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

11. Obsessive-Compulsive Disorders
Obsessions
Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind
Compulsions
Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

12. Obsessive-Compulsive Disorders (Cont.)
Body dysmorphic disorder
Hoarding disorder
Hair pulling and skin picking disorders
Other compulsive disorders
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

13. Anxiety Disorders Epidemiology Comorbidity Etiology Biological
Genetics
Neurobiological
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

14. Psychological Theories
Psychodynamic theories
Sigmund Freud
Harry Stack Sullivan
Behavior theories
Cognitive theories
Cultural considerations
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

15. Application of the Nursing Process
Assessment
General assessment of symptoms
Self-assessment
Assessment guidelines: anxiety and obsessive-compulsive disorders
Nursing diagnosis
Outcomes identification
Planning
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

16. Application of the Nursing Process (Cont.)
Implementation
Mild to moderate levels of anxiety
Severe to panic levels of anxiety
Counseling
Teamwork and safety
Promotion of self-care activities
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

17. Case Study (Cont.)
What would be some appropriate interventions for the parent whose child is missing at the mall and is experiencing panic level anxiety?
Maintain a calm manner
Remain with the parent
Minimize environmental stimuli if possible
Move to a quieter setting if possible and stay with the parent
Use clear, simple statements and repetition
Use a low-pitched voice; speak slowly
Recognize the anxious person's distress
Being willing to listen
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

18. Implementation Pharmacological interventions
Antidepressants
Anti-anxiety drugs
Other classes
Psychobiological interventions
Integrative therapy
Health teaching
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

19. Advanced Practice Interventions
Cognitive therapy
Behavioral therapy
Relaxation training
Modeling
Systematic desensitization
Flooding
Response prevention
Thought stopping
Cognitive-behavioral therapy
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

20. Audience Response Questions
What is your usual level of anxiety on the day of a nursing exam?
Mild
Moderate
Severe
Panic
ANS: Answers will vary.
Discuss the benefits of mild anxiety.
REF:
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

21. Audience Response Questions
The television character “Monk” appears to have which anxiety problem?
Panic disorder
Generalized anxiety disorder
Posttraumatic stress disorder
Obsessive-compulsive disorder
ANS: D
Identify some of Monk’s behaviors, including straightening his umbrellas and using tissues. Help students differentiate between obsessions and compulsions.
REF:
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